Abstract
BackgroundLow competency for determination of brain death (BD) and unfamiliarity with Japanese BD (JBD) criteria among pediatricians were highlighted in previous nationwide studies. Because the JBD criteria were amended in 2010 to allow organ donation from pediatric brain-dead donors, we created a 2-day training course to assess knowledge and improve skill in the determination and diagnosis of pediatric BD.MethodsThe course consisted of two modules: a multistation round session and a group discussion session, and was bookended by a before and after 20-question test. In the multistation round session, participants rotated between stations staffed by expert faculty members. For hands-on skill development, we used the Sim Junior 3G™ simulation mannequin (Laerdal Medical, Wappingers Falls, NY, USA) for structured simulations. In the group discussion session, we implemented simulation-based role playing to practice decision making in prepared scenarios of complicated clinical situations. We investigated the participants’ impressions of the course by self-scoring and questionnaires.ResultsOf 147 pediatric healthcare providers from multiple specialties who participated in this course, 145 completed the entire process. The course was evaluated in three aspects with self-scoring and questionnaires: (1) value (4.58 ± 0.64; range 1–5); (2) time schedule (2.40 ± 0.61; range 1–3); and (3) difficulty (2.89 ± 0.43; range 1–5). Finally, participants scored the entire course program (9.64 ± 1.69; range 1–11). Various positive feedbacks were obtained from a total of 93 participants. Post-test scores (83.6 %) were significantly higher than pre-test scores (62.9 %).ConclusionThis simulation-based course represents an effective method to train pediatric healthcare providers in determining BD in Japan and may improve baseline knowledge of BD among participants.
Highlights
Low competency for determination of brain death (BD) and unfamiliarity with Japanese BD (JBD) criteria among pediatricians were highlighted in previous nationwide studies
According to the Japanese BD (JBD) criteria, organ donation must be offered to the family after the patient is clinically determined to be in “a state that can be considered to be BD”
The course was designed to train pediatric healthcare providers in determining BD based on the JBD criteria practice parameters in two separate modules: a multistation round session and a group discussion session
Summary
Low competency for determination of brain death (BD) and unfamiliarity with Japanese BD (JBD) criteria among pediatricians were highlighted in previous nationwide studies. Because the JBD criteria were amended in 2010 to allow organ donation from pediatric brain-dead donors, we created a 2-day training course to assess knowledge and improve skill in the determination and diagnosis of pediatric BD. Japan legalized brain death (BD) as human death only when the patient was to be an organ donor This created a double standard (Aita 2011) of human death after decades of nationwide debate. Only 154 designated pediatric intensive care units (PICU) beds are available for the entire Japanese pediatric population (Nakawaga 2010). Physicians, especially those involved in pediatric care, have not been evaluated for clinical competence to perform BD examinations
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